Nepal Work Plan · 2019-01-14 · SOP Standard Operating Procedures STH Soil-Transmitted Helminths...

Nepal Work Plan FY 2019

Project Year 8

October 2018–June 2019

ENVISION is a global project led by RTI International in partnership with CBM International, The Carter Center, Fred Hollows

Foundation, Helen Keller International, IMA World Health, Light for the World, Sightsavers, and World Vision. ENVISION is funded by

the US Agency for International Development under cooperative agreement No. AID-OAA-A-11-00048. The period of performance

for ENVISION is September 30, 2011, through September 30, 2019.

The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International

Development or the United States Government.

ENVISION FY19 PY8 Nepal Work Plan

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ENVISION PROJECT OVERVIEW

The United States Agency for International Development (USAID) ENVISION project (2011–2019) is

designed to support the vision of the World Health Organization (WHO) and its member states by

targeting the control and elimination of seven neglected tropical diseases (NTDs), including, lymphatic

filariasis (LF), onchocerciasis (OV), schistosomiasis (SCH), trachoma, and three soil-transmitted helminths

(STH; roundworm, whipworm, and hookworm). ENVISION’s goal is to strengthen NTD programming at

the global and country levels and support ministries of health to achieve their NTD control and

elimination goals.

At the global level, ENVISION—in close coordination and collaboration with WHO, USAID, and other

stakeholders—contributes to several technical areas in support of global NTD control and elimination

goals, including the following:

• Technical assistance

• Monitoring and evaluation (M&E)

• Global policy leadership

• Grants and financial management

• Capacity strengthening at global and country levels

• Dissemination

At the country level, ENVISION provides support to national NTD programs in 19 countries in Africa, Asia,

and Latin America by providing strategic technical, operational, and financial assistance for a

comprehensive package of NTD interventions, including the following:

• NTD program capacity strengthening

• Strategic planning

• Advocacy for building a sustainable national NTD program

• Social mobilization to enable NTD program activities

• Mapping

• Drug and commodity supply management

• Supervision

• M&E

In Nepal, ENVISION project activities are implemented by RTI in collaboration with the Government of

Nepal and WHO.


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TABLE OF CONTENTS

ENVISION PROJECT OVERVIEW ..................................................................................................................... ii

TABLE OF TABLES ......................................................................................................................................... iv

ACRONYMS LIST ........................................................................................................................................... iv

COUNTRY OVERVIEW .................................................................................................................................... 1

1. General Country Background ........................................................................................................... 1

a) Administrative Structure ........................................................................................................ 1

b) Other NTD Partners ................................................................................................................ 1

2. National NTD Program Overview ..................................................................................................... 3

a) Lymphatic Filariasis (combined with STH if appropriate) ...................................................... 3

b) Trachoma ............................................................................................................................... 5

c) Soil-transmitted Helminths .................................................................................................... 5

3. Snapshot of NTD Status in Country .................................................................................................. 7

PLANNED ACTIVITIES ..................................................................................................................................... 8

1. NTD Program Capacity Strengthening ............................................................................................. 8

a) Strategic Capacity Strengthening Approach .......................................................................... 8

b) Capacity Strengthening Objectives and Interventions ........................................................... 8

c) Monitoring and Evaluating Proposed Capacity Strengthening Interventions ....................... 9

2. Table 4: Project Assistance .............................................................................................................. 9

a) Strategic Planning .................................................................................................................. 9

b) NTD Secretariat .................................................................................................................... 11

c) Building Advocacy for a Sustainable National NTD Program ............................................... 11

d) Mapping ............................................................................................................................... 12

e) MDA Coverage ..................................................................................................................... 12

f) Social Mobilization to Enable NTD Program Activities ......................................................... 13

g) Training ................................................................................................................................ 15

h) Drug and Commodity Supply Management and Procurement ........................................... 17

i) Supervision for MDA ............................................................................................................ 18

j) M&E...................................................................................................................................... 18

k) Supervision for M&E and DSAs ............................................................................................ 19

l) Dossier Development ........................................................................................................... 19

3. Maps .............................................................................................................................................. 20


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APPENDIX 2: Work Plan Timeline................................................................................................................ 23

APPENIDX 4. Table of USAID-supported Regions and Districts in FY19 ...................................................... 25

TABLE OF TABLES

Table 1: Non-ENVISION NTD partners working in country, donor support, and summarized

activities .............................................................................................................................. 2

Table 2: Snapshot of the expected status of the NTD program in Nepal as of September 30, 2018

............................................................................................................................................ 7

Table 3: Social mobilization/communication activities and materials checklist for NTD work

planning ............................................................................................................................ 14

Table 4: Training targets ................................................................................................................. 17

ACRONYMS LIST

ALB Albendazole

CDC US Centers for Disease Control and Prevention

CHD Child Health Division

CNTD Center for Neglected Tropical Diseases

DAG Data for Action Guide

DPHO District/Public Health Office

DEC Diethylcarbamazine Citrate

DEO District Education Office

DoE Department of Education

DQA Data Quality Assessment

DSA Disease-Specific Assessment

DWSS Department of Water and Sanitation Services

EDCD Epidemiology and Disease Control Division

EU Evaluation Unit

FCHV Female Community Health Volunteers

FOG Fixed Obligation Grant

FTS Filariasis Test Strips

FY Fiscal Year

GoN Government of Nepal

GTMP Global Trachoma Mapping Project

HQ Headquarters

ICT Immunochromatographic test

IEC Information, Education, and Communication

JRSM Joint request for selected medicines

LF Lymphatic Filariasis


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M&E Monitoring and Evaluation

MDA Mass Drug Administration

Mf Microfilaraemia

MMDP Morbidity Management and Disability Prevention

MoE Ministry of Education

MoHP Ministry of Health and Population

NHSP3 National Health Sector Programme III

NGO Nongovernmental Organization

NNJS Nepal Netra Jyoti Sangh

NTD Neglected Tropical Disease

NTP National Trachoma Program

PC Preventive Chemotherapy

PPICD Policy, Planning, and International Cooperation Division

PSAC Pre-School-Aged Children

Q Quarter

RPRG Regional Program Review Group

SAC School-Aged Children

SAE Serious Adverse Events

SAFE Surgery–Antibiotics–Facial cleanliness–Environmental improvements

SCM Supply Chain Management

SEARO South-East Asia Region

SOP Standard Operating Procedures

STH Soil-Transmitted Helminths

STTA Short-Term Technical Assistance

TAS Transmission Assessment Survey

TF Trachomatous Inflammation—Follicular

ToT Training of Trainers

TSS Trachoma Surveillance Survey

TT Trachomatous Trichiasis

TWG Technical Working Group

USAID United States Agency for International Development

VBDRTC Vector Borne Disease Research Training Center

WHO World Health Organization


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COUNTRY OVERVIEW

1. General Country Background

a) Administrative Structure

Under its new federal structure, Nepal has been divided into 7 provinces and 77 districts (an increase

from 75). The districts are divided into 753 local levels: 6 metropolitan cities, 11 sub-metropolises, 278

urban municipalities, and 458 rural municipalities (gaunpalikas) depending on population and

infrastructure. Urban and rural municipalities are divided into wards, which are the country’s lowest

level of administration. Each municipality is responsible for implementing government programs and

delivering services through local health facilities, education, and other units.

Under the new structure, the current district public health offices (DPHOs) and district education offices

(DEOs) may no longer be used; instead, their functions are expected to be executed by local bodies and

coordinated by district coordination committees under the provincial and central government. Under

the new structure, federal ministries of social development will be created in each province and be

responsible for health and education.

Female community health volunteers (FCHVs) are typically the main cadre that conducts public health

campaigns at the community and household levels; they report to ward-level health facilities of the local

units. Health workers supervise the activities of the FCHVs. In fiscal year 2019 (FY19), health workers will

be the primary drug distributors for lymphatic filariasis (LF) mass drug administration (MDA) in the

remaining 15 districts.

b) Other NTD Partners

Nepal’s NTD program is supported by two collaborating partners in addition to the ENVISION project

(Table 1). The World Health Organization (WHO) provides technical assistance to the Ministry of Health

and Population (MoHP), coordinates drug donations for LF and soil-transmitted helminths (STH) through

the Joint Request for Selected Medicines (JRSM) form and provides funding for training, supervision, and

monitoring of LF morbidity management activities. The Center for Neglected Tropical Diseases (CNTD),

at the Liverpool School of Tropical Medicine, provides funding to the MoHP for social mobilization

during LF MDA and for LF morbidity management, particularly for morbidity mapping and hydrocele

surgeries.

The Epidemiology and Disease Control Division (EDCD), with funding from the Government of Nepal

(GoN) and CNTD, provides counseling, information, and orientation for self-care to persons living with

lymphedema in areas where the Morbidity Management and Disability Prevention (MMDP) project is

being implemented.


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Table 1: Non-ENVISION NTD partners working in country, donor support, and

summarized activities

Partner Location

(Regions/States) Activities

In FY18, was

USAID

providing

direct financial

support to this

partner

through

ENVISION?

Partner

MoHP

Central level/

all endemic

areas

• Providing program leadership and

national-level coordination among

partners

• Developing national strategy and

plan of action for NTDs

• Conducting pre-school and school-

based STH deworming activities

• Procuring DEC for LF MDA

• Supporting meeting/training costs

• Conducting program

implementation, monitoring, and

supervision of district-level

activities

• Managing/coordinating

surveillance and survey

• Funding to treat PSAC and

pregnant women for STH

No MoHP

WHO Country Office

Central level/

all endemic

districts

• Providing technical assistance for

program activities, MDA, MMDP

• Coordinating drug and diagnostic

donations and shipments

• Monitoring and supervising LF

MDA activities

No

WHO

Country

Office

CNTD

Central/district

level (12

districts)

• Mapping LF morbidity

• Managing morbidity

• Conducting social mobilization and

advocacy

No CNTD

Integrated Nutrition

Program

(Good Nutrition -II

SUAHARA) - HKI

Central level/

40 districts

• Sanitation and hygiene related

activities in 40 USAID-funded

SUAHARA districts with a goal of

declaring these districts open

defecation free

No

Social Empowerment

and Building

Accessibility Centre

(SEBAC) Nepal

District level/

6 districts

• Funding for water system

construction, toilet construction,

and hygiene and sanitation in

Achham, Darchula, Dolakha, Kailali,

Kanchanpur, and Sindhupalchowk

districts

No


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2. National NTD Program Overview

Nepal is endemic for three preventive chemotherapy (PC) NTDs: LF, trachoma, and STH. In April 2018,

WHO validated elimination of trachoma as a public health problem in Nepal.

LF elimination activities are implemented by the EDCD of the MoHP and began in 2003. STH-control

activities are implemented by the Child Health Division (CHD) of the Ministry of Education (MoE) and

started in 2008, targeting school-age children (SAC) in grades 1–5, and expanding in 2009 to target SAC

in grades 1–10. The trachoma elimination program commenced in 2002 and activities were

implemented by a Nepali nongovernmental organization (NGO), Nepal Netra Jyoti Sangh (NNJS),

through the National Trachoma Program (NTP). Following validation of elimination, they will continue to

support post-validation planning and related activities.

In 2010, the GoN approved the “Plan of Action for Neglected Diseases in Nepal: An Integrated National

Control Program (2010–2014).” This document focused on the joint efforts of the MoHP and the MoE to

control and eliminate PC NTDs. Subsequently, the GoN developed “National Guidelines and Tentative

Plan of Action for the Elimination of Lymphatic Filariasis in Nepal (2016–2020)” and is preparing a new

plan of action for 2016–2030 with an integrated work plan for NTDs.

In addition to the technical leadership of the MoHP, the GoN provides financial support for the

implementation of MDA for the elimination of LF and the control of STH. This includes the purchase of

diethylcarbamazine citrate (DEC) used during LF MDA and funding for community-based LF MDA in more

than half of the country’s districts. The MoHP and MoE provide joint funding for school-based STH MDA

in all 77 districts. The MoHP provides technical oversight of the trachoma program and also funds

trachomatous trichiasis (TT) surgeries. The Ministry of Water Supply provides funds to improve water

and sanitation systems and contributes to the environmental improvement activities that form part of

the trachoma and STH programs.

The NTD Technical Working Group (TWG) coordinates implementation and monitoring of MDA and

surveys. The TWG also develops strategies for specific technical challenges, such as improving coverage

in urban areas. In districts co-endemic for LF and STH, one round of STH MDA is conducted by the EDCD,

and a second round is carried out by the CHD. In districts where only STH is endemic or where the LF

program has successfully reached stop-MDA status, the CHD coordinates school-based MDA.

a) Lymphatic Filariasis (combined with STH if appropriate)

The national LF program is housed in the MoHP’s EDCD. The NTD plan of action clearly outlines

strategies and plans to eliminate LF as a public health problem by 2020, through MDA with albendazole

(ALB) and DEC on an annual basis for six years. Nepal is more than halfway to achieving its LF elimination

goal and is on track for all LF-endemic districts to have stopped MDA in 2021. By the end of FY18, of the

61 LF-endemic districts, 46 are expected to have stopped MDA.

Mapping was conducted with a combination of immunochromatographic test (ICT) cards, night blood

surveys of microfilaremia, and clinical cases. Initially, 15 districts were identified as not requiring

mapping, based on their high altitude and low vector abundance. In 2012, two mountainous districts,

Gulmi and Khotang, that border LF-endemic districts were mapped using the original WHO mapping

protocol and ICT cards as the diagnostic. They were found to be non-endemic for LF. Similarly, in 2012

Darchula, initially mapped and found non-endemic, was re-mapped and results showed 1.3%

prevalence, which is above the treatment threshold and therefore commenced MDA. The remaining 12

districts—Dolakha, Dolpa, Humla, Jumla, Kalikot, Manang, Mugu, Mustang, Rasuwa, Sankhuwasabha,


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Solukhumbu, and Taplejung—have not been mapped on the assumption that they are unlikely to be

endemic given their mountainous geography.

USAID’s support for Nepal’s NTD programs commenced in 2009 under the NTD control program and

continues under the ENVISION project. Support for the LF program includes funding for annual MDA in

selected districts; printing and delivery of information, education, and communication (IEC) materials

and training manuals for all LF-endemic districts; and reporting forms for all LF MDA districts. Other

activities include LF sentinel and spot-check site surveys, post-MDA coverage surveys, transmission

assessment surveys (TASs), and technical assistance to develop the NTD plan of action, monitoring and

evaluation (M&E) plan, and national LF guidelines. The ENVISION project has also supported planning

and review meetings, training for FCHVs prior to MDA, and training and orientation to GoN officials and

NGO personnel on TAS. Since 2011, USAID has provided technical and financial support for LF/STH MDA

in 56 districts, Pre-TAS in 61 districts, TAS in 38 districts, LF re-mapping in 3 districts, and LF baseline

surveys in 10 districts. Five districts (Chitwan, Makwanpur, Nawalparasi, Parsa, and Rupendehi) passed

TAS III in February 2018 and will continue with post-validation surveillance through the established

health care system.

Low treatment coverage in some communities remains a challenge. To address this, the MoHP

implements a targeted treatment strategy in those communities. This approach includes a special

advocacy campaign that targets private health facility staff, professional bodies, schools, local clubs of

ethnic minorities, municipality staff, and media persons, as well as enhanced monitoring and

supervision. Alongside this, the MoHP has established additional treatment booths for drug

administration in public places, such as in hospitals (public and private), schools, and local community

clubs. The MoHP also moved to use health workers, rather than FCHVs, to carry out house-to-house

visits for drug administration in selected communities. The health workers provide drinking water for

swallowing the medicine as well as the medicine itself. This approach continued in FY18 and reported

coverage increased slightly. Preliminary findings from monitoring and supervisory visits conducted in

Banke during the 2018 MDA continue to identify rumors and fear of side effects as the main reasons for

refusal of treatment.

The GoN convened an LF expert meeting in March 2018 to address the continued challenge of low

coverage in some districts and failure of Pre-TAS. This brought together representatives from the 15

districts that have failed Pre-TAS/TAS surveys to share experiences and seek guidance for future LF

MDA. Following the experts’ opinion, the GoN plans to modify its LF MDA strategy. The program will use

the following approaches when planning MDA:

• mobilize health workers for distribution of LF MDA drugs

• review the number of days for LF MDA according to the number of available health workers in

guanpalikas (municipality) and the target population

• initiate social mobilization activities at least two months prior to LF MDA dates

• intensify supportive supervision and monitoring by using the WHO standard check list.

Morbidity Management

The GoN has been implementing lymphedema management activities and hydrocele surgeries since

FY15 with supplemental funding from CNTD. Activities are targeted on the worst-affected villages based

on reporting from the DPHOs during MDA campaigns. In FY15, 38 of the 41 LF MDA districts reported

10,354 cases of either lymphedema or hydrocele. Central, zonal, and district hospitals, and regional

health directorates, in coordination with the DPHOs perform hydrocele surgeries. In FY16 and FY17,


5

morbidity mapping in four districts (Dhading, Kanchanpur, Okhaldhunga, and Saptari) identified 5,551

hydrocele cases and 2,049 lymphedema cases. An additional 69 people were identified as having both

conditions. By the end of FY17, a total of 5,237 cases of hydrocele surgery had been conducted of the

identified 5,551. In FY18, morbidity mapping is being conducted in 8 districts (Baitadi, Bara, Dang,

Gorkha, Lamjung, Nawalparasi, Palpa, and Panchthar). Cumulative results from 12 mapped districts

identified 8,989 hydrocele cases, 3,174 lymphedema cases, and 96 people identified with both

conditions. An additional 16 districts will be mapped in FY19, leaving 33 districts that will require

mapping. The funding covers all costs related to surgeries. Doctors performing surgeries are trained by

GoN, and there is a referral system from communities to designated hospitals to treat suspected cases.

This commitment and budget allocation for surgery demonstrates the GoN’s leadership role in

addressing LF morbidity management using the existing health system.

b) Trachoma

In April 2018, Nepal was officially validated by the WHO as having eliminated trachoma as a public

health problem.

The MoHP outsources all eye-care services to networks of local NGOs that operate eye hospitals and

clinics. The NTP is housed within NNJS, a local NGO with a network of eye hospitals in all seven provinces

of the country. The NTP, which has been implementing trachoma control activities since 2002, receives

oversight from the MoHP but operates semi-independently. With ENVISION’s financial and technical

support, the NTP completed the final three rounds of Zithromax® MDA and implemented 12 trachoma

impact surveys by 2015. Trachoma pre-validation surveys (surveillance surveys) in all 20 endemic

districts were implemented from 2015–2017 following Global Trachoma Mapping Project (GTMP)

methodology, and all indicated a trachomatous inflammation—follicular (TF) prevalence of <5% and TT

prevalence of <0.1%. In December 2016, a national trachoma dossier development workshop was

organized by the MoHP, NTP, NNJS, and RTI for all eye-care stakeholders. The workshop facilitated the

development of a draft trachoma elimination dossier, reviewed nationwide data, and identified

remaining data gaps. These gaps included the identification of districts that were below the treatment

threshold for MDA but had a baseline TT prevalence >0.2%. To address this, TT-only surveys were

conducted in four districts in December 2017, and the dossier was finalized and formally submitted to

WHO in March 2018.

Following validation, the MoHP and NNJS will continue to conduct post-validation surveillance through

the health system. A system is in place for service providers to refer trichiasis patients to district eye

hospitals, and NNJS will continue to provide support for trichiasis surgery services in all its eye hospitals.

All TT surgeries will be closely monitored and data on the residence of the patient will be collected and

analyzed; action will be taken if an unexpected number of TT surgeries is reported in any geographical

area. Furthermore, NNJS is proposing, if funding is available, post-validation surveillance to monitor for

any recrudescence of trachoma in two districts (Doti and Kapilvastu) with high baseline prevalence.

c) Soil-transmitted Helminths

All 77 districts in Nepal are endemic above the treatment threshold of 20% for STH, based on district-

level studies carried out in the 1990s and 2000s. The NTD control program aims to control STH in SAC

through biannual treatment with ALB to reduce the intensity of infection and prevent infected

individuals from developing morbidity. The CHD implements STH-control activities for pre-school-age

children (PSAC) and SAC. Pregnant women are treated by the Family Health Division under the safe

motherhood program. The CHD collaborates with the MoE to conduct school-based deworming,


6

targeting 6.1 million SAC annually, as a major sub-activity of the School Health and Nutrition Program. In

2012, the program achieved national coverage for public school children in grades 1–10. In 2013, the

program was expanded to include children in private schools in the same grades. ENVISION funded an

STH prevalence survey in FY14–FY15, which found a national STH prevalence of 20.7%. In 2015, a

complementary survey to determine the prevalence of STH among PSAC and women of child-bearing

age was conducted with funding from the MoHP, United Nations Children’s Fund, and the US Centers for

Disease Control. The results of this survey have not been disseminated.

STH MDA is coordinated with LF MDA where co-endemic. In these areas, one round of MDA is

conducted with DEC+ALB. Treatment of PSAC and pregnant women for STH is implemented with

support from other funders. As the LF program scales down, the government-funded STH program has

taken over deworming through a school-based platform. EDCD shares with the CHD information about

districts where LF MDA has stopped. Based on this, the government-funded STH MDA resumes its SAC

deworming program as usual, e.g., twice a year under the school health program.


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3. Snapshot of NTD Status in Country

Table 2: Snapshot of the expected status of the NTD program in Nepal as of September

30, 2018

Columns C+D+E=B for each

disease* Columns F+G+H=C for each disease*

MAPPING GAP

DETERMINATION MDA GAP DETERMINATION

MDA

ACHIEVEMENT DSA NEEDS

A B C D E F G H I

Disease

Total No. of

Districts in

COUNTRY

No. of

districts

classifie

d as

endemic

**

No. of

districts

classifie

d as

non-

endemi

c**

No. of

districts

in need

of initial

mappin

g

No. of districts

receiving MDA

as of 09/30/18

No. of districts

expected to be

in need of MDA

at any level:

MDA not yet

started, or has

prematurely

stopped as of

09/30/18

Expected No. of

districts where

criteria for

stopping district-

level MDA have

been met as of

09/30/18

No. of districts

requiring DSA

as of 09/30/18 USAID

funde

d

Others

LF

77

63 14 0 4 11 0 48

FY18

Pre-TAS:

10****

TAS: 10****

FY19

re-Pre-TAS: 4

TAS1: 10

TAS2: 12

TAS3: 14

Onchocerci

asis 0 77 N/A N/A N/A N/A N/A N/A

Schistosomi

asis 0 77 N/A N/A N/A N/A N/A N/A

STH 77 0 0 4 73 0 0 0

Trachoma 22 55 0 0 0 0 22 0

*If Columns C+D+E do not equal B for mapping of each disease, or if Columns F+G+H do not equal C for treatment of each disease, please

reconfirm figures and then add detailed footnotes explaining the discrepancies.

**If mapping results are not available at the time of work planning, add a footnote explaining how many districts were mapped and for which

endemicity data are not yet available. Do not count them as districts in need of initial mapping (Column E).

****Pre-TAS and TAS under FY18 will be completed by October 31, 2018.


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PLANNED ACTIVITIES

1. NTD Program Capacity Strengthening

a) Strategic Capacity Strengthening Approach

Capacity goals

The goals of FY19 capacity strengthening activities are to: (1) continue to strengthen the program

management capacity of EDCD/MoHP to adequately respond to emerging challenges of the LF program

and to implement high-quality M&E activities, and (2) document achievements against the goals of

elimination of LF and the control of STH.

Capacity strengthening strategy

i) DSA Implementation: As part of efforts to build a strong M&E culture and skillsets of the EDCD,

ENVISION will continue to strengthen the implementation of disease-specific assessments (DSA). This

will be done through implementation of WHO TAS guidelines, improving the TAS outcomes checklist,

TAS supervision checklist, and other available resources to ensure high quality surveys from the design

through reporting stages. ENVISION will continue to provide the required technical support for DSAs

through monitoring and supportive supervision. On-the-job training, mentoring, coaching, and findings

from supervisory visits using the TAS checklists will be used as a process improvement to enhance the

capacity and skills of EDCD.

ii) Monitoring and Supervision: Using the MDA and TAS supervision checklists, ENVISION will

continue to build monitoring and supervision skills within the EDCD/MoHP to ensure the

implementation of quality DSAs and MDA. The objective is to enhance performance observation,

improve standards and quality, follow up on issues, and use the feedback for performance

improvement, mentoring, and training.

iii) NTD Program Management: ENVISION will enhance the program management skills of staff

members of the national NTD program using the global NTD Toolbox developed by the ENVISION

project. The overall objective of this strategy is to ensure the national NTD program takes full

ownership, management, and maintenance of the WHO integrated database; plans and implements

successful MDA; improves the quality of reporting to WHO and other partners; and increases the use of

data for decision-making (Data Action Guide).

b) Capacity Strengthening Objectives and Interventions

Objective 1: Improve DSA Implementation

Intervention 1: ENVISION will conduct on-the-job training with the new staff of the EDCD and MoHP to

orient and train them on the WHO TAS guidelines to build their skillsets. On-the-job training will be done

daily by the ENVISION Program Manager and M&E Coordinator as they work with the EDCD staff in

planning and implementing activities.

Objective 2: Enhance Monitoring and Supervision

Intervention 1: The ENVISION team will work directly with the EDCD and MoHP staff on use of the

supervision checklists for TAS and MDA, timely reporting and data analysis, and quality DSA

implementation.


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Intervention 2: The ENVISION team and the key EDCD staff will identify research topics for publication.

Proposed topics for abstracts include TAS failures, social mobilization activities to improve coverage and

compliance, country ownership, and progress towards trachoma elimination. As part of this, a number

of potential research topics were identified for development for publication. In FY19, the process to

build the capacity of the ENVISION team and EDCD to document programmatic successes and challenges

will continue with support from ENVISION US staff.

Objective 3: Strengthen NTD Program Management

Intervention 1: NTD Toolbox orientation for national NTD staff. In FY18, ENVISION used the ENVISION

NTD Toolbox as a key resource to build the capacity of the national NTD program. In FY19, ENVISION will

promote this resource within the national NTD network, including the new staff of the MoHP, EDCD, and

local governments responsible for implementing NTD activities as one of the vehicles for capacity

strengthening.

c) Monitoring and Evaluating Proposed Capacity Strengthening Interventions

ENVISION staff will continue to meet regularly with EDCD to discuss the progress of capacity

strengthening activities and needs in key technical, managerial, financial, and operational areas. Other

meetings described under Strategic Planning and Advocacy will also serve as opportunities for ENVISION

and EDCD to discuss capacity strengthening needs, opportunities, and progress.

ENVISION will ensure an effective dialogue through meetings and phone calls with the EDCD/MoHP and

all stakeholders on issues relating to identifying NTD capacity gaps, opportunities, and priorities. This

will lead to awareness of establishing resource mobilization objectives and priorities among all the

stakeholders.

2. Table 4: Project Assistance

a) Strategic Planning

In FY19, RTI will provide support to EDCD to implement the following LF MDA planning activities.

Activity 1: TWG Meetings

The TWG meetings coordinate the three independent NTD programs (LF, trachoma, and STH). In FY19

ENVISION will fund two TWG meetings, attended by the ENVISION Resident Program Advisor and

Program Manager. These meetings will provide oversight for the national NTD programs, and ENVISION

will report on the progress of planned ENVISION-funded activities and provide technical expertise for

any proposed changes in strategy that may come up during the meeting. ENVISION will also continue to

advocate and sensitize TWG members to implement expert recommendations, identify innovative ways

to increase MDA coverage in low-performing municipalities and districts, address coverage issues in

non-compliant populations, and work closely with districts that have failed Pre-TAS and TAS, and those

at risk of failing. The need for GoN to increase funding for NTD activities post-ENVISION will be a key

agenda item discussed during the FY19 meetings.

Activity 2: LF MDA Annual Review Meeting

ENVISION will provide financial support for four provincial review meetings following MDA. This is an

important process improvement activity for LF/STH MDA. These meetings take place at the regional


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level following MDA and are facilitated by EDCD and the ENVISION team, and include participants from

the central, provincial, and district levels. The meetings review MDA activities and discuss lessons

learned to inform plans for future campaigns in line with EDCD and ENVISION priorities. During the

meetings, preliminary MDA coverage results, challenges, and resource management issues are

discussed. The municipality coverage data received through ENVISION and EDCD are presented for

discussion. ENVISION will work with the assigned health officers under the new structure to use the NTD

data action planning tool to lead the review meetings.

Activity 3: Provincial LF MDA Planning Meetings (5 events)

ENVISION will provide funding for provincial planning meetings in five provinces, an important pre-MDA

planning activity. EDCD, in partnership with RTI ENVISION staff, will facilitate the meetings. The meetings

are designed to engage and mobilize key provincial stakeholders and orient municipal level health

supervisors to promote the successful implementation of upcoming LF MDAs. Progress on

recommendations from previous regional review meetings will be reviewed, with discussions focusing

on developing municipal and community-specific strategies for increasing coverage and compliance. In

FY19, ENVISION in coordination with EDCD will use these platforms to advocate the importance of NTD

activities and how they should be prioritized for funding in the planning and rollout of the new federal

governance system.

Activity 4: District-Level Coordination Meeting with Stakeholders

In FY19, ENVISION will provide funding to municipalities where the district headquarters is located in 4

districts to organize district-level sensitization and awareness meetings. As part of the pre-MDA planning

process, other government and NGO stakeholders are expected to mobilize their officials in advance of

MDA. District stakeholders, including members of civil society organizations, will be invited to the

district headquarters to participate in the events. These district-level coordination meetings will provide

opportunities to orient stakeholders on the status of LF in the district, the need for MDA, and how they

can support the campaigns. Ultimately, the goals of these sensitization meetings are to increase the

involvement of stakeholders in developing solutions to increase MDA coverage and to address concerns

and misinformation.

Activity 5: Municipality-Level Orientation (Palika-level Orientation)

ENVISION will fund 38 LF MDA municipality-level orientations across 4 districts. The one-day orientation

will inform municipal political, social and religious leaders, teachers, and other stakeholders about the LF

program and upcoming MDA and get their support and commitment to encourage participation from

within their groups. Municipal health staff will present results from the previous year’s MDA, the

successes and challenges, and will outline plans for FY19 MDA with community-specific actions to

improve coverage. ENVISION staff, in coordination with EDCD and WHO technical staff, will attend most

of these orientations in the four ENVISION-supported districts (Banke, Bardiya, Kailali, and Kanchanpur).

Activity 6: MDA Planning Meeting

ENVISION will fund LF MDA planning meetings in the 38 municipalities of the 4 districts. Municipality

officials and health workers will participate in the planning meetings. Municipal level health staff will

present the results from the previous year’s MDA, successes and challenges, and will discuss in detail

the plans for FY19 MDA including the community-specific actions to improve coverage. Outcomes from

this meeting will be a municipality level MDA implementation plan for upcoming treatment. The plan

will include social mobilization activities, including any group/community-specific targeted social

mobilization activities, MDA logistics, specific actions to address any logistical and operational

challenges, monitoring and evaluation activities of the MDA, supervision, serious adverse event (SAE)


11

management, and drug supply management plans. Supervisors for the municipality will also be trained

on the expectations of their role and reporting requirements during the MDA and use of the supervisory

coverage tool. ENVISION will promote the use of the NTD data action guide (DAG) as a means to analyze

sub-district level data to identify priority areas for MDA planning efforts and will facilitate discussion on

improving MDA coverage and compliance. ENVISION staff, in coordination with EDCD and WHO

technical staff, will attend most of these planning meetings.

Activity 7: Hospital-level Orientation

Hospitals play an important role in managing referred AEs/SAEs cases during LF MDA as they act as

referral centers. ENVISION will support a hospital level orientation in four districts (Banke, Bardiya,

Kailali and Kanchanpur). The purpose of this orientation is to orient hospital staff including doctors,

nurses and other paramedics about the LF MDA, possible adverse events, and their supportive role in

managing those in their hospitals. This is important because some will be part of the municipalities’

rapid response team.

b) NTD Secretariat

The NTD Secretariat plays an important role in fostering coordination among the MoHP divisions

implementing LF, STH, and trachoma, and with the Department of Education (DoE) and Department of

Water and Sanitation Services (DWSS). This coordination includes high-level support for planning and

budgeting processes to all divisions and stakeholders. For example, the Secretariat works with all

divisions to present their NTD-specific budget activities to the PPICD chief. The Secretariat also facilitates

strategic and policy dialogue among NTD stakeholders by coordinating regular technical and oversight

meetings for all NTD program offices. ENVISION will fund NTD Secretariat running costs including

communications and supplies.

c) Building Advocacy for a Sustainable National NTD Program

Activity 1: Central-Level Sensitization Meetings

ENVISION will support two central-level sensitization meetings for media houses, journalists, and health

professionals. These interaction meetings will be organized by EDCD at the central level. Their purpose is

sensitization on the objectives of LF MDA campaigns, provision of briefing materials, and answering

questions about NTDs and the safety of the drugs (DEC + ALB). During these, EDCD/MoHP will seek

support from these professional groups to ensure successful implementation of LF MDA. Clear

communication channels will be established and shared with media houses and journalists to seek

clarification on any misinformation or rumors.

Activity 2: Trachoma celebration

To celebrate the achievement of elimination of trachoma as a public health problem in Nepal, ENVISION,

in cooperation with NNJS, MoHP and WHO, will organize a half-day celebration. Participants will include

high-ranking government officials, district health representatives from endemic areas, WHO, USAID and

other stakeholders that helped the country reach this milestone.

Activity 3: School health education

Students are considered to play an important role in ensuring treatment compliance, their own

participation and the education of parents and other community members of the benefits of taking

drugs during LF MDA. In FY19, ENVISION will continue to support school health education sessions in


12

four districts (Banke, Bardiya, Kailali and Kanchanpur). These sessions will be conducted by local health

workers in selected schools of their health facilities catchment areas.

Activity 4: District-Level Journalist Interaction Meetings

Positive media attention during LF MDA and the provision of correct information and clear messages to

the population have been identified as crucial in building confidence in the safety of drugs. The national

NTD program has found that engaging with the media as partners in the planning and implementation of

MDA at the central and local levels has improved the dissemination of accurate news reports and

prevented negative campaigns and false rumors about the treatment. There were not been any

reported SAE cases in FY18. Four district-level journalist sensitization and interaction meetings will be

organized to build on the successes of the previous media interactions. The municipality where the

district headquarters is located will invite local print and audio-visual journalists to a one-day

sensitization meeting to discuss the purpose of the LF campaign, achievements, and challenges; provide

briefing materials; and answer questions about the disease. ENVISION and EDCD staff will attend some

of these events to answer questions and help with the sensitization.

d) Mapping

Trachoma: Trachoma has been eliminated from Nepal. No further mapping is needed.

LF: Sixty-five districts have been mapped; 63 districts are endemic and 2 are non-endemic. Twelve

districts have never been mapped due to their high altitude and the lack of evidence of vector

transmission. RTI has encouraged EDCD/MoH to discuss with the WHO/Regional Program Review Group

(RPRG) documenting recent evidence of malaria and dengue transmission in some of the highland non-

endemic LF districts to confirm that no additional mapping is necessary.

STH: ENVISION supported a national prevalence survey in FY13–FY14, and no further mapping is

required. The results indicated that the far-Western Development Region of Nepal has the lowest

estimated prevalence for all three infections (Ascaris, Trichuris, hookworm). The mid-Western

Development Region has the highest prevalence of 27.7% for at least one infection. Among all the

infections, Ascaris infection has the highest prevalence of 22.7% in the mid-Western Development

Region. The Western Development Region has the second highest prevalence (21.9%) of Ascaris

infection.

e) MDA Coverage

Activity 1: MDA Campaign

ENVISION will fund an MDA census in the four MDA districts. Prior to MDA, FCHVs will visit every

household in their designated areas and update their registers. The names and ages of householders are

updated to ensure their eligibility to take the drugs during LF MDA. The census register will be used to

plan drug requirements.

Activity 2: SAE Management

In certain communities, people are still reluctant to take the drugs, which has caused districts to miss

their coverage targets. As a result, the EDCD has developed a strong system to address any reported

SAEs. If an SAE occurs during LF MDA, the municipality will respond through a rapid response team of

physicians and health workers in coordination with local hospitals. The municipality will also report any


13

suspected or confirmed SAE case to EDCD, which then reports it to the WHO country office and to

ENVISION.

f) Social Mobilization to Enable NTD Program Activities

Activity 1: Television Broadcasts

As confirmed by coverage surveys conducted from 2011–2017, depending on the geographical area

(rural and urban) mass media including radio and TV are effective sources of MDA awareness. In urban

areas, the national and local TV channels are considered very reliable in providing information on LF

MDA. The media plays an important role in communicating the LF MDA campaign schedule. ENVISION

will fund public service announcements about LF MDA for national television broadcast. Messages will

include information to the public about the date and location of MDA, benefits of the drugs, and the

safety of DEC+ALB.

In previous years announcements have been broadcast for only 3 days before and during LF MDA. This

limited broadcast has not been able to draw the attention of the majority of the population. In

discussions to identify how to make it more effective, district managers suggested starting the

announcement well before the MDA. Therefore, in FY19 ENVISION is planning to support one daily

broadcast for 25 days over a two-month period, increasing up to three time per day leading up to the

MDA. The broadcast schedule will be finalized in coordination with EDCD.

Activity 2: Newspaper Notice

It is a legal requirement in Nepal to publicize all upcoming MDA and provide information on the safety

of medications in the national newspaper. Information regarding the MDA and the government’s

commitment to the safety of the drugs is published in the two GoN-owned national newspapers in

Nepali and in English (Gorkhapatra and The Rising Nepal). At the request of EDCD, ENVISION will fund LF

MDA-related advertisements in these newspapers to inform the general population about the date and

locations of upcoming LF MDA, the safety of the drugs, and their importance.

Activity 3: Telefilm for LF MDA sensitization

WHO experts have suggested increasing efforts in social mobilization and awareness using different

modalities. In Nepal health programs for leprosy, tuberculosis, HIV, and immunization have used

telefilms for program awareness and have been able to achieve good coverage. In FY18 ENVISION

supported the development of video clips with LF messages, statements from people suffering from

lymphedema and hydrocele, and messages from leaders and doctors in the communities. This clip was

able to raise community awareness and generate trust in the LF elimination program and in taking the

drugs.

Based on this, ENVISION plans to support the MoHP/LF elimination program to produce a telefilm in

which popular actors from Nepal will act out storylines that help deliver LF messages. This will be

approximately 30 minutes in length. This telefilm will address misbeliefs and fear of treatment side

effects. It will be produced in close coordination with EDCD and other divisions of MoHP responsible for

health communication.

Activity 4: Community FM Radio for LF MDA Awareness

ENVISION will provide funding, for municipalities in the four districts to conduct MDA awareness

campaigns using local FM radio stations. The local radio campaigns are expected to persuade key

beneficiary audiences to participate in MDA, through reminding them of the importance of treatment.


14

The local FM radio stations are an important channel to reach beneficiary populations and provide

information about MDA and NTDs.

Activity 5: Community-Level Mobilization

In the 38 municipalities of the 4 districts funded by ENVISION, local health workers and FCHVs will hold

meetings with local community leaders and school teachers to inform them of the MDA a few weeks

before it is scheduled to occur.

Table 3: Social mobilization/communication activities and materials checklist for NTD

work planning

Category Key messages Target

population

IEC

activity

(e.g.,

materials,

medium,

training

groups)

Where/whe

n will they

be

distributed

Frequency

Has this

material/message

or approach been

evaluated?

If no, please detail

in narrative how

that will be

addressed.

MDA

Participation

MDA will take

place at all

wards of 38

municipalities

of 4 districts

Community

members

Posters/

Banners

Hung in all

health

facilities and

at center

points/

schools 1

week before

MDA

Once Yes

The drugs

provided are

free and safe,

who should

and should not

take the drugs

Community

members

Radio, TV,

newspaper

Radio, TV,

newspaper

Local station,

2 weeks in

advance of

LF MDA

campaign

Messages

play 7 times

per week

during the

hours of

7am – 10

pm;

message

printed 1

time in

news-

papers

Yes

Some side

effects are

normal, minor,

and will pass

Information

about MDA

date and

location

Community

members

Local FM

radio,

newspaper

, health

workers,

FCHVs

2 weeks in

advance of

LF MDA

campaign

Daily Yes

Disease

Prevention

Taking NTD

drugs for 6

years will

prevent

Community

members

Radio, TV,

newspaper

2 weeks in

advance of

LF MDA

campaign,

Messages

play 7 times

per week

during the

Yes


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Category Key messages Target

population

IEC

activity

(e.g.,

materials,

medium,

training

groups)

Where/whe

n will they

be

distributed

Frequency

Has this

material/message

or approach been

evaluated?

If no, please detail

in narrative how

that will be

addressed.

diseases Local station hours of

7am – 10

pm

Other Promoting

visibility of

NTD Program

Community

members

Posters/

Banners

Hung in all

health

facilities and

at center

points/

schools 1

week before

MDA

Once Yes

g) Training

Activity 1: LF MDA Training of Health Workers

One-day municipal-level training of trainers (ToT) for health facility staff will be carried out by a

municipal health coordinator who has participated in the provincial-level planning meeting. MoHP,

WHO, and RTI staff will facilitate these trainings in selected municipalities. This will ensure that health

facility staff will work as trainers with strong working knowledge of LF, the purpose of MDA, MDA data

reporting chain, management of SAEs, and supervisory responsibilities. As part of the FY16 data quality

assessment (DQA) recommendations, ENVISION will continue to strengthen instruction on recording and

reporting during training sessions for health workers. This activity will be conducted at the municipality

level as a part of LF MDA for health facility staff.

Activity 2: LFA MDA Training for FCHVs

The FCHV role in FY19 MDA will be to assist health workers who will administer drugs directly during LF

MDA. They will be retrained on counseling community members to take the drugs. A one-day training

will be held for FCHVs participating in the LF MDA to ensure they understand the MDA’s purpose, their

role, how to manage SAEs, and how to complete the record sheets.

Activity 3: National-Level Orientation (re-Pre-TAS and TAS)

The purpose of this activity is to strengthen the M&E capacity of the EDCD/MoHP and to inform

national-level stakeholders and district-level managers about the planned DSAs. ENVISION organize

these national-level events in collaboration with EDCD and WHO to orient/train provincial district

managers, focal persons/lab technicians, and representatives from MoE/DoE on LF TAS. Participants will

be oriented on the use of LF diagnostics, the TAS methodology, and the use of the TAS checklist.


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Activity 5: TAS (TAS2 and TAS3) District-Level Orientation

As part of the sensitization and community engagement efforts, the implementing organization

contracted to implement TAS2, and TAS3 will organize an orientation session in all survey districts

before the beginning of field surveys. In attendance will be of all the municipality health staff of survey

districts, and representatives of stakeholders. Journalists and representatives of the district coordination

committee, district administration office, district security office, and association of private schools will

also be invited to this event. ENVISION and representatives from EDCD will participate to supervise and

provide technical support.

Activity 6: TAS (TAS2, and TAS3) Enumerator Training

The purpose of these activities is to prepare skilled cadres of technical professionals who can conduct

high-quality DSAs. This capacity building effort will be sustainable as a country resource for future

events. Under this activity, the implementing organization will recruit enumerators and implement

training for field survey teams in coordination with EDCD, ENVISION, and WHO. This training session will

train field researchers and laboratory personnel on the survey objectives, ethical considerations, use of

FTS, data recording and reporting, reporting of positives to the DPHO, proper waste disposal, and survey

sampling methodologies.


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Table 4: Training targets

Training

groups Training topics

Number to be trained

Number

of

training

days

Location of

training(s)

Name other

funding

partner (if

applicable,

e.g., MoHP,

SCI) and what

component(s)

they are

supporting

New Refresher Total

trainees

Health

Workers

• MDA supervision

and monitoring

• SCM and SOP for

MDA drug

management

• Social mobilization

for MDA

• Record keeping

and reporting

after MDA

• Who should and

should not take

drugs

• SAE management

0 1,735 1,735 1 Municipality None

FCHVs

• Social mobilization

for MDA

• Record keeping

and reporting of

treatments

• Who should and

should not take

drugs

• Referrals of S/AE

cases

0 3,702 3,702 1 144 Health

Facilities None

TAS Refresher

Training

• Importance of TAS

• Methodology

• Sample collection

• Use FTS for

detection of LF

0 140 140 2 Central

level None

h) Drug and Commodity Supply Management and Procurement

Activity 1: Joint Request for Selected Medicines

EDCD develops the JRSM with technical support from WHO and ENVISION. The MoHP uses the WHO

JSRM form to request ALB for LF and STH MDA. ENVISION has been building the capacity of EDCD by

closely working with the Division to produce the required data for the preparation of the JRSM. In FY19,

ENVISION will continue to provide this critical technical oversight through support to EDCD and WHO to

ensure the JRSM is completed correctly, is of high quality, and submitted to WHO on schedule.


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Activity 2: NTD Drug Quantification

Quantification and procurement of DEC is handled by the MoHP Logistics Management Division, in

consultation with EDCD, and procurements are done on a multi-year basis (every two years). The

quantification and forecasting is conducted using population targets in coordination with program

districts. ENVISION provides minimal technical support in preparing the forecast and drug needs for

MDA. In FY19, ENVISION will monitor the quantification and forecasting process to ensure the required

quantity of drugs is ordered for on-time delivery.

Activity 3: Transportation of drugs

All drugs are stored in the central warehouse upon arrival in Nepal. All drugs procured for MDA are

transported to regional stores for re-distribution to district health stores. The distribution of the drugs to

districts and health facilities is based on the drug forecast and the supply plan developed by EDCD for

distribution from the national warehouse. A buffer stock system is also established within the NTD

supply chain system to ensure that in every catchment area, EDCD and the MoHP are able to

immediately respond to any potential stock-out situation during MDA. The Ministry of Social

Development of each province is responsible for transportation of drugs to municipalities following the

supply plan provided by EDCD. ENVISION supports the transportation of MDA drugs from the

municipalities to health facilities. In FY19, ENVISION will support 38 municipalities in 4 districts to

transport and deliver ALB and DEC drugs to health facilities, where they will be provided to the drug

distributers to give to the eligible population in the community for directly observed uptake during the

campaign.

i) Supervision for MDA

Activity 1: LF MDA Supervision

As in previous years, in FY19 ENVISION will fund central-level staff from MoHP/EDCD and district level

supervisors to conduct MDA supervision. During house-to-house visits, the drug distributors support

each other to ensure high quality MDA and proper recording. Their work will be supervised by municipal

supervisors. RTI also conducts joint supervision with the MoHP and WHO during and after the MDA

campaign. Together with the central-level supervision team, the MoHP will involve municipality

authorities and provincial staff in supportive MDA supervision. ENVISION also funds municipal-level

supervision (transportation only) in 38 municipalities of 4 LF MDA districts to the municipality.

j) M&E

WHO Integrated Database

In FY19, ENVISION will continue to collaborate with EDCD to ensure the database is updated with new

programmatic data. ENVISION is gradually transitioning the management of the database to

EDCD/MoHP and will be providing only technical support, maintenance, and on-the-job training for the

staff at EDCD; providing quality assurance; and ensuring that MDA data received from the field are

entered in a timely manner. ENVISION will also ensure that EDCD/MoHP develop the culture to use the

information generated by the database for decision-making and as a one-stop-shop for all data-related

dossier activities. In FY19, ENVISION will continue to monitor and provide management support to the

NTD program to update and use the database for data storage and decision-making.


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Activity 1: TAS2

In FY19, ENVISION will conduct TAS2 with FTS in 12 districts, namely Argakhachi, Bhaktapur, Kaski,

Kathmandu, Lalitpur Urban, Okhaldhunga, Pyuthan, Rolpa, Rukum, Salyan, Saptari, Siraha) in 10

evaluation units (EUs) that passed TAS1 in 2016.

Activity 2: TAS3

In FY19, ENVISION will conduct TAS3 with FTS in 14 districts, namely Dhading, Dhanusha, Gorkha,

Kavrepalanchowk, Mahottari, Nuwakot, Palpa, Ramechhap, Rautahat, Sarlahi, Sindhuli, Sindhupalchowk,

Syangja, Tanahu) in 5 EUs that passed TAS2 in 2016.

k) Supervision for M&E and DSAs

Activity 1: Supervision for M&E and DSAs

In FY19, ENVISION will fund supervision activities related to the implementation of TAS2, and TAS3

planned activities. During the period of performance, ENVISION will meet with NGO staff, provide

technical trainings as necessary, and observe field work using the relevant checklists and supervisory

tools. Implementation issues will be discussed and corrective actions put in place to improve processes.

In addition, EDCD/MoHP and WHO staff will provide additional supervision as necessary.

l) Dossier Development

In FY19, ENVISION will orient the EDCD on the LF elimination dossier and begin drafting the document

and complete the data annex through FY19. ENVISION will also work with the EDCD to ensure the

integrated database is updated regularly and understand how that will allow them to complete the

dossier, showing the importance of historical information within the dossier, and will work with the

EDCD to develop simple strategies to collect and complete the MMDP section. ENVISION will identify a

simple way to collect existing MMDP patient estimates that are currently kept at district levels and ways

to regularly update this information through annual reporting.


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3. Maps


21


22


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APPENDIX 2: Work Plan Timeline

FY19 Activities

Management Support

Office Operations

Project Assistance

Strategic Planning

Technical Working Group Meeting (2 meetings)

LF MDA Annual Review Meeting (4 regions)

NTD Secretariat

Consultant, Supplies, Communication, Travel

Building Advocacy for a Sustainable National NTD Program

Provincial LF MDA Planning Meeting (5 events)

Central-Level Sensitization Meeting (2 events)

Mapping

MDA Coverage

MDA in 4 Districts (Includes advocacy, social mobilization, training, supervision)

Social Mobilization to Enable NTD Program Activities

Television Broadcasts

Newspaper Notice

Telefilm for LF MDA Sensitization

Training

Drug Supply and Commodity Management and Procurement

Supervision for MDA

Supervision of MDA: LF

Monitoring and Evaluation

TAS2 (12 districts)


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FY19 Activities

TAS3 (14 districts)

Supervision for Monitoring and Evaluation and DSAs

Supervision of LF TAS2 (ENVISION staff)

Supervision of LF TAS3 (ENVISION staff)

Dossier Development

Informal LF Dossier Orientation


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APPENIDX 4. Table of USAID-supported Regions and Districts in FY19

LF OV SCH STH TRA LF OV SCH STH TRA

1 Banke x x TAS1

2 Bardiya x x

3 Pyuthan TAS2

4 Rolpa TAS2

5 Rukum TAS2

6 Sa lyan TAS2

7 Ka i la l i x x

8 Kanchanpur x x

9 Dhankuta TAS1

10 Il lam TAS1

11 Jhapa TAS1

12 Morang TAS1

13 Okhaldhunga TAS2

14 Panchthar TAS1

15 Lamjung TAS1

16 Parbat TAS1

17 Baglung TAS1

18 Kapi lvas tu TAS1

19 Kathmandu TAS2

20 La l itpur Urban TAS2

21 Bhaktapur TAS2

22 Saptari TAS2

23 Siraha TAS2

24 Rautahat TAS3

25 Sarlahi TAS3

26 Dhanus a TAS3

27 Mahottari TAS3

28 Sindhul i TAS3

29 Dhading TAS3

30 Nuwakot TAS3

31 Kavrepa lanchowk TAS3

32 Ramechhap TAS3

33 Sindhupalchowk TAS3

34 Kaski TAS2

35 Argakhanchi TAS2

36 Pa lpa TAS3

37 Syangja TAS3

38 Tanahun TAS3

39 Gorkha TAS3

West

Far West

East

Midwest

West

Centra l

MDADSA

(list type: TAS2, TSS, etc.)RegionHealth

Districts

Mapping

(list

disease(s)

Baseline

sentinel

sites (list

disease(s)


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